System of Health Accounts in Ireland Future Health Summit City West 26 May 2016 www.cso.ie 1
System of Health Accountsin Ireland
Future Health Summit
City West
26 May 2016
www.cso.ie 1
Headline results
• New estimate of current health expenditure for year 2013
• €18.4 billion in 2013
• 10.2% of GDP
• 12.4% of GNI
• 71% funded by government
• 15% funded by household out of pocket spending
• 14% by voluntary schemes – mainly health insurance
www.cso.ie 2
What is the System of Health Accounts?
• Format for reporting health care expenditure agreed between OECD, WHO, Eurostat
– Extension of core National Accounts
• Answers 3 main questions
– Where does the money to finance the health system come from?
– Who does the money go to?
– What kind of (functionally defined) services are performed and what type of goods are purchased
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What’s new?
• First detailed profile of Irish current health expenditure in accordance with System of Health Accounts, 2011 (SHA)
• Previously only high level estimates– Total
– Public / private
– Current / capital
• Now detailed breakdown of current spending by 3 classifications
www.cso.ie 4
What is the System of Health Accounts?
• Based on the International Classification for Health Accounts (ICHA) with classifications for
–health care financing schemes (ICHA-HF);
–health care by service provider industries (ICHA-HP);
–health care by function (ICHA-HC);
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Boundary of health care
• Functional classification (ICHA-HC) is key to defining the boundary of health care
• Excludes social care – difficult in practice
• Review of Irish data has led to inclusion of wider range of services as health care than previously reported
• Main changes – more long-term care for older people and people with a disability now included
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Old versus new estimate
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4.6
5.6
6.6
7.3
8.1
8.9
9.6
10
.7
11
.7
11
.3
9.7
9.4 9
.7
5.0
6.1
7.2
8.0
8.9
10
.3 10
.8
12
.2
13
.6
13
.7
13
.4
13
.1 13
.4
13
.1
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
€b
illio
n
Public Current Health Expenditure - old approach
Public Current Health Expenditure - revised 2000-2012, new approach 2013
Health expenditure 2000-2013
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0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
€m
illio
n
Total Health Care Expenditure Current Expenditure Capital Expenditure
Current health expenditure 2000-2013Ireland and OECD
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0%
2%
4%
6%
8%
10%
12%
14%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
Current Expenditure % GDP, Ireland Current Expenditure % GNI, Ireland
Current Expenditure % GDP, OECD Average (adjusted)
Current health expenditure 2000-2013Public/Private
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-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
€m
illio
ns
Current Expenditure - Total Current Public Expenditure Current Private Expenditure
Detailed Preliminary 2013
results
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Who pays for health care in Ireland?
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71%
14%
15%
Health Care Expenditure Distributed by Financing Schemes, 2013
HF.1 Government
HF.2 Voluntary Health CarePayments
HF.3 Household Out-of-Pocket
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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
USA
Greece
Australia
Ireland
Spain
Finland
Germany
Italy
France
New Zealand
UK
Denmark
Netherlands
Health Expenditure by Type of Financing, 2013(Ireland and selected OECD countries)
Government Out of pocket Other voluntarySource: OECD and CSO
Who provides health care in Ireland?
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9%
15%
1%
20%
20%
35%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Retailer of Medical Goods
Ancillary Health Care Provider
Ambulatory Health Care Provider
Long-Term Residential Facilities
Hospitals
Health Care Expenditure by Provider, 2013
€m
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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Germany
Belgium
United States
Ireland
Netherlands
Switzerland
Finland
France
Sweden
Spain
Denmark
Health Expenditure by Provider (HP), 2013(Ireland and selected OECD countries)
Hospitals Nursing and residential care Ambulatory providers Retailers OtherSource: OECD and CSO
What kind of health care is funded in Ireland?
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4%
16%
3%
22%
55%
0 2,000 4,000 6,000 8,000 10,000 12,000
Other Health Care Functions
Medical Goods (Non-Specified by Function)
Ancillary Services
Long-Term Care (Health)
Curative and Rehabilitative Care
Health Care Expenditure By Health Care Function, 2013
€m
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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Norway
Belgium
Netherlands
Germany
France
Ireland
Denmark
Switzerland
Spain
Greece
Austria
United States
Health Expenditure by Function (HC), 2013(Ireland and selected OECD countries)
Curative & rehabilitative care Long-term care Medical goods Other ServicesSource: OECD and CSO
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62%
43% 12% 37%
34%
7%
0 2,000 4,000 6,000 8,000 10,000 12,000
Long-Term Care(Health)
Curative andRehabilitative Care
Type of Care by Mode of Provision, 2013
Inpatient Day Outpatient Home-Based
€m
Cross-Classifying
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1.Who provides what kind of care?
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22%
88%
17%
95%
66%
11%
83%
99.7%
4%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Medical Goods Retailers
Ambulatory Providers
Residential Facilities
Hospitals
Providers (HP) by Health Care Function (HC) , 2013
Curative and Rehabilitative Care Long-term care (health) Medical Goods Other Services
€m
2.Who funds which type of care?
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69%
80%
67% 21%
31%
16%
12%
0 2,000 4,000 6,000 8,000 10,000 12,000
Medical Goods
Long-term care (health)
Curative and Rehabilitative
Health Care Function (HC) by Financing (HF), 2013
Government Voluntary Payments Out-of-Pocket
€m
3.Who funds which providers?
www.cso.ie 22
74%
72%
69%
75%
69%
26%
29%
28%
28%
21%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Medical Goods Retailers
Ambulatory Provider
Residential Facilities
Hospitals
Type of Provider (HP) by Financing
Government Voluntary Payment Out-of-Pocket
€m
Going forward
• Revised 2013 data and new 2014 data to be submitted to Eurostat on 31st May and thereafter annually.
• National publication in June/July.
• Data user seminar in Q3 2016.
• Detailed tables for 2011 and 2012 to be produced in 2017.
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For data and further information
CSO Publication
Ireland’s System of Health Accounts, Annual Results 2013 (Preliminary)
http://www.cso.ie/en/releasesandpublications/er/sha/systemofhealthaccounts2013/
International Data
OECD: - http://stats.oecd.org/ - see health expenditure and financing under Health theme
Eurostat: -http://ec.europa.eu/eurostat/web/health/health-care/data/database
Please refer to the following methodological papers on the CSO’s website
http://www.cso.ie/en/surveysandmethodology/nationalaccounts/
Mapping of Health Care Services in Ireland to the Functions Classification (ICHA – HC) within the System
of Health Accounts
Mapping of Health Care Services in Ireland to the Functions Classification (ICHA – HC) within the System
of Health Accounts
Mapping of Health Care Providers in Ireland to the Provider Classification (ICHA – HP) within the System
of Health Accounts